Urethra - Benign lesions

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Urethra

Benign lesions

Reviewers: Turki Al-Hussain, M.D. (see Reviewers page)
Revised: 24 December 2012, last major update June 2012
Copyright: (c) 2002-2012, PathologyOutlines.com, Inc.

Caruncle

General
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● Only in female urethra
● Resembles small raspberry protruding from external urethral meatus
● Considered a reactive polypoid lesion
● Patients may be asymptomatic, although commonly they experience dysuria, urinary frequency, obstructive symptoms
● Bleeds easily, may become infected
● Often recurs, perhaps due to persistence of inciting factors

Treatment
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● Excision

Micro description
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● Three histologic subgroups are described, based on the most prominent component:
1. Papillomatous
2. Angiomatous
3. Granulomatous
● Highly vascularized fibroblastic connective tissue with chronic inflammation, dilated blood vessels, hyperplastic epithelium
● Invaginations of urothelium extending into stroma are common, showing rounded nests with cystic or glandular luminal spaces, similar to urethritis cystica/glandularis, without intestinal metaplasia (Hum Pathol 2012 Mar 6 [Epub ahead of print])

Differential diagnosis
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● Carcinoma

Diverticula

General
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● Usually women, either acquired or congenital
● In adults, usually secondary to infection, trauma, calculus, obstruction, dilation, or inflammation of paraurethral gland
● Carcinoma may arise in diverticula very rarely

Microscopic:
● Lined by urothelium, with or without squamous or glandular metaplasia
● Submucosa is often edematous and inflamed
● Nephrogenic adenoma may arise in diverticula

Inverted papilloma

General
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● Rare in urethra
● Similar to those in bladder

Leiomyoma

General
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● Most common soft tissue tumor of urethra
● Relatively common in women, rare (<10 reported) in men
● Case report in 48 year old man with quadriplegia (Arch Pathol Lab Med 2000;124:302)

Nephrogenic (mesonephric) adenoma

General
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● Metaplastic change, not neoplastic, common in urethra
● Similar to lesions in bladder neck

Papilloma

General
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● Rare in urethra
● Similar to those in bladder

Polypoid urethritis

General
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● Urethral counterpart of polypoid cystitis

Micro images
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Bladder: broad based papillae lined by normal/reactive urothelium with edematous congested stroma

Prolapse

General
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● May occur in childhood and simulate a neoplasm.

Prostatic urethral polyp

General
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● See also Prostate chapter
● Mostly in adult men
● Usually asymptomatic but may cause hematuria
● Cystoscopically, the lesions appear as discrete small papillary growths that may be solitary or extensive, producing a velvety coating on the mucosa

Micro description
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● Papillary fronds contain a thin fibrovascular core and are covered by normal prostatic acinar epithelium
● Occasionally, foci of residual urothelium can be seen

Micro images
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Various images

End of Urethra > Benign lesions

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